Depression Rating Scores Research Articles

Neuromonitoring-guided anesthesia depth versus four-minute anesthesia-to-stimulation time interval in electroconvulsive therapy for depressive disorders - A single-blinded, prospective, randomized and controlled study.

Anesthesia depth influences seizure quality in patients undergoing electroconvulsive therapy (ECT). EEG-based neuromonitoring has been shown to detect adequate anesthesia depth for ECT. Anesthesia depth-guided ECT management may therefore be a reliable alternative to the predetermined anesthesia-to-stimulation time interval. Patients with depressive disorders and a Montgomery-Asberg Depression Rating Score ≥ 18 were randomly assigned. The anesthesia depth-guided group received stimulation between Narcotrend™ index ratings of 41 and 64 and was compared to the control group with a predetermined anesthesia-to-stimulation time interval of four minutes. The primary endpoint was seizure quality. A total of 225 interventions were conducted in 30 patients. Significant differences were observed between the two groups regarding stimulation intervals (225.0 ± 34.2 s vs. 240.0 ± 0 s; p < 0.001) and the index before electric stimulation (45.0 ± 15.7 vs. 35.0 ± 13.0; p < 0.001). No significant differences in overall seizure quality were found between the groups. The midictal amplitude was higher in the anesthesia depth-guided group (209.2 ± 92.6 vs. 152.6 ± 80.0; p = 0.009). Because of inadequate anesthesia depth, 54 interventions were discontinued for safety reasons. The number of per protocol completed interventions is small due to high exclusion rate from protocol violations. Anesthesia depth-guided ECT management did not significantly improve overall seizure quality compared to a four-minute anesthesia-to-stimulation time interval.

Partial Residual Plots as an Integrated Model Diagnostic Tool in Model-Based Meta-Analysis.

The use of partial residual plots (PRPs) was explored as a model diagnostic tool in Model-based Meta-Analysis (MBMA). Mathematical derivations illustrating the concepts were followed by an MBMA example using publicly available literature data of anti-depressive treatments with fluoxetine and venlafaxine. An Emax dose-response model was identified for venlafaxine while a constant drug effect combining all dose levels vs. placebo was identified for fluoxetine. The larger the mean baseline Hamilton Depression Rating (HAMD) score, the larger the expected drug effect (P = 0.0122), based on the likelihood ratio test. Mean baseline HAMD score (range) was 25.4 (23.5, 29.4) and 20.8 (15, 26) while mean placebo change from baseline (range) was -9.02 (-12.2, -4.8) and - 6.22 (-10.9, -1.3) for venlafaxine and fluoxetine, respectively. Average baseline HAMD score appeared larger for venlafaxine compared to fluoxetine, albeit a wider range for fluoxetine. Placebo response seemed lower but also more variable in fluoxetine compared to venlafaxine studies. Observed data points tended to deviate from model predictions when the mean baseline HAMD and placebo response values associated with those data points differed substantially from the corresponding values used for the model prediction. Normalizing observed data addressed this, providing a "like-to-like" comparison with model predictions in PRP when assessing the effect of one covariate (dose) after normalizing for other covariates/effects (placebo response and mean baseline). PRPs provide a robust integrated diagnostic tool in MBMA that uses all data to show the correlation between response and any covariate while controlling for other covariates included in the model.

Maintenance Repetitive Transcranial Magnetic Stimulation for Major Depressive Disorder: A Meta-analysis.

Repetitive transcranial magnetic stimulation (rTMS) is an effective therapy for acute treatment of major depressive disorder (MDD). However, the efficacy and optimal strategy of delivering maintenance rTMS beyond acute treatment remains unclear. This meta-analysis aims to quantify the treatment effect of maintenance rTMS therapy in MDD and compares the difference in treatment effect between the fixed and rescue maintenance rTMS protocols. We conducted a meta-analysis of 14 studies (N = 705) comparing depression rating scores before and after maintenance rTMS. Standardized mean scores adjusted for sample size (Hedges g) were used as the effect size. Subgroup analysis was performed to compare the fixed and rescue maintenance rTMS treatment. Maintenance rTMS was associated with a statistically significant improvement in depression scores (standardized mean difference [SMD] = 0.75; confidence interval [CI] = -1.25 to -0.25). The random effects model had the Q value = 142.67 (P < 0.0001) and I2 = 90%, supporting significant heterogeneity among studies. The prediction interval yielded a possible effect size from -2.54 to 1.05. The subgroup analysis showed a stronger treatment effect for rescue maintenance protocol (SMD = -1.17; CI = -2.13 to -0.21) compared to fixed maintenance protocol (SMD = -0.45; CI = -1.00.16). Although not statistically significant (Q-between = 2.56, df-between = 1, P = 0.1096), a large difference in effect size was observed between subgroups. Maintenance rTMS appears to be an effective strategy for maintaining remission and preventing relapse in MDD. Significant heterogeneity among the studies warrants caution in interpreting the results. These findings suggest the need for standard protocols and consensus guidelines for the optimal delivery of maintenance rTMS treatment.

Electroconvulsive Therapy (ECT): A Scotland Wide Naturalistic Study of 4,826 treatment episodes

IntroductionDespite its apparent efficacy in the treatment of a range of psychiatric disorders, electroconvulsive therapy (ECT) is viewed by some as a contentious treatment. Although most clinicians and researchers consider ECT a safe and effective treatment, there are ongoing and significantly publicised concerns about potential side effects.ObjectivesTo explore use of ECT across Scotland in a large naturalistic clinical sample across an 11-year period from 2009 to 2019. To consider the efficacy and side effects of ECT for a range of common psychiatric disorders including, depression, bipolar depression, schizophrenia, and mania.MethodsUsing data from the Scottish Electroconvulsive Therapy (ECT) Accreditation Network (SEAN), information was collected for all adults who had received ECT. Variables included age, sex, Scottish Index of Multiple Deprivation (SIMD) quintile, International Classification of Diseases, Tenth Edition (ICD-10) diagnosis, indication for ECT, Mental Health Act status, consent status, entry and exit Montgomery-Asberg Depression Rating Scores (MADRS), entry and exit Clinical Global Index Severity CGI-S) scores and reported side effects. Side effects were recorded as present if the side effect was reported at any point during the episode of treatment.Results4826 ECT episodes were recorded. The majority of episodes were in women (68.4%, n=3,301). Average age at treatment onset was 58.52 years. Males were slightly younger (m=58.24 years vs f= 58.65 years, p= 0.20). Mean number of treatments/episode was 9.59 (95% CI 9.32 – 9.85). Mean treatment dose delivered was 277.75mC (95%CI 272.88 – 282.63mC).2920 episodes of treatment had CGI-S entry and exit recorded. At entry, mean CGI-S indicated marked illness (5.03 95% CI 4.99-5.07). Recipients with schizophrenia had the highest CGI-S score (5.45 95% CI 5.21-5.60), followed by those with post-partum disorders (5.38, 95% CI 4.61-6.14). At exit, mean CGI scores indicated borderline illness (2.07, 95% CI 2.03-2.11), recipients diagnosed with mixed affective state had the lowest CGI-S score (1.72, 95% CI 0.99-2.47) followed by those with schizoaffective disorder (2.01, 95% CI 1.76-2.42).Anaesthetic complications (n=34) and prolonged seizures (n=38) were rare, occurring in &lt;1% of treatment episodes. Cardiovascular complications were reported in 2.2% (n= 102). Nausea was reported in 7.2% (n= 334) and muscle aches in 12% (n=560). Confusion was reported in 19% (n=879) and cognitive side effects were reported in 26.2% (n=1212). One third of treatment episodes reported confusion or cognitive side effects (33.1%, n=1545).ConclusionsFrom this large naturalistic clinical sample, ECT appears to be effective in improving illness severity as measured by CGI-S score. While some side effects (such as prolonged seizures and cardiovascular complications) were rare, others (such as confusion or cognitive side effects) were relatively common.Disclosure of InterestNone Declared

P127 Characteristics and outcomes of geriatric patients with depression who received pharmacogenomic testing for antidepressant medication selection

Objective:Pharmacogenomic testing for antidepressant medication selection is widely available, and patients with treatment-resistant depression regularly inquire about it. Psychiatrists and primary care providers have little guidance on when to obtain pharmacogenomic testing. We reviewed the characteristics and outcomes of a sample of geriatric patients who received this testing.Methods:Retrospective review of patients ages 65 and older with ICD-10 diagnoses of depressive disorders (F32.0-F33.9), followed at Mayo Clinic Rochester, who received pharmacogenomic testing between 1/1/2018 and 12/31/2022 to guide antidepressant medication selection. Patients were included if there were Patient Health Questionnaire 9-item (PHQ-9) depression rating scores up to 3 months before and 3 months after pharmacogenomic testing. Demographic information, cytochrome P-450 CYP2D6 and CYP2C19 phenotypes, PHQ-9 scores, ordering provider (psychiatrist or primary care provider), and resulting medication changes were collected. Paired t-tests compared differences between before and after PHQ-9, with statistical significance p&lt;0.05.Results:Approximately 1% of patients with a depressive disorder received pharmacogenomic testing. After limiting to patients with PHQ-9 before and after testing, 287 patients met inclusion criteria. 66% were female, mean age 72.3 yrs (±SD 5.7, range 65.0-90.7), and 95% were Caucasian. CYP2D6 phenotypes were 9% poor, 48% intermediate, 39% extensive (normal), 3% rapid metabolizer. CYP2C19 phenotypes were 3% poor, 25% intermediate, 39% extensive, 33% rapid metabolizer. Mean PHQ-9 before testing was 10.8 (±SD 6.4), and after testing was 9.8 (±SD 6.5) (p=0.0041). Data collection regarding ordering provider and medication changes were still pending.Conclusion:The clinical utilization of pharmacogenomic testing appeared to be low. CYP2D6 and CYP2C19 phenotypes were as expected (except for more 2C19 rapid metabolizers), suggesting treatment resistance was less likely related to these genetic factors. There was a statistically significant decrease of 1 point in the mean PHQ-9, which would not be clinically significant. However, many other factors still need to be explored, such as details about medications and gene-medication interactions, ordering provider’s knowledge about pharmacogenomic testing, whether medication changes were made, aging factors influencing pharmacokinetics, medical and psychosocial burdens, and other concurrent treatments. Further research will hopefully allow more practical guidance on whether and when to obtain pharmacogenomic testing.

Efficacy and Safety of Esketamine Nasal Spray in Patients with Treatment-Resistant Depression Who Completed a Second Induction Period: Analysis of the Ongoing SUSTAIN-3 Study.

Treatment-resistant depression (TRD) is a chronic illness requiring long-term treatment. Esketamine nasal spray (ESK) has been studied in several long-term trials of patients with TRD, including SUSTAIN-1 (NCT02493868) and SUSTAIN-3 (NCT02782104). This subgroup analysis of SUSTAIN-3 evaluated patients with TRD who received a second induction (IND) and maintenance treatment with ESK plus oral antidepressant (AD) after a relapse in SUSTAIN-1. Patients aged 18-64 years who achieved stable remission or response with ESK and subsequently relapsed after randomization to continue ESK or switch to placebo nasal spray (PBO) in SUSTAIN-1 and entered the IND phase of SUSTAIN-3 were included in this interim analysis. Response (≥50% improvement in total score from baseline for Montgomery-Åsberg Depression Rating Scale [MADRS] and Patient Health Questionnaire 9-item [PHQ-9]), remission (MADRS score ≤12; PHQ-9 total score <5), changes in depression rating scores (measured as mean change from baseline), and safety were evaluated (incidence of treatment-emergent and serious adverse events [AE]). Of the 96 eligible patients who entered IND in SUSTAIN-3, 32 (33.3%) were taking ESK+AD at the time of relapse in SUSTAIN-1 and 64 (66.7%) were taking AD+PBO. Substantial improvements in depressive symptoms were observed over the second IND phase in both groups and were maintained over the optimization/maintenance (OP/M) phase. MADRS response rates following a second IND were 71.9% and 73.4% for previously relapsed (PR) ESK+AD and PR-AD+PBO, respectively; remission rates were 62.5% and 60.9%, respectively. During the IND and OP/M phases, 58.3% and 83.3% of patients experienced a treatment-emergent AE, respectively. No patients discontinued due to an AE during the second IND. Patients with TRD benefitted from receiving a second IND and maintenance treatment with ESK and no new safety signals were identified.

Exploring New Electroencephalogram Parameters in Electroconvulsive Therapy.

This pilot study aims to evaluate a novel metric based on the power spectrum of the EEG recordings from ECT-induced seizures-its association to volume changes in the hippocampus after ECT and improvement in depression rating scores. Depressed patients treated with ECT underwent brain magnetic resonance imaging before and after treatment and the EEG from each seizure was recorded (N = 29). Hippocampal volume changes and EEG parameters were recorded in addition to clinician-rated and self-reported measures of depressive symptoms. The slope of the power law in the power spectral density of the EEG was calculated. Multivariate linear models relating seizure parameters to volume change or clinical outcome were systematically and successively simplified. The best models were selected according to Akaike information criterion. The slope of the power law was steeper in the right than the left hemisphere (P < 0.001). Electroencephalogram measures were included in the best models of volume change for both hippocampi as well as in the models explaining clinical outcome ( P = 0.014, P = 0.004). In this pilot study, novel EEG measures were explored and contributed in models explaining the variation in volume change in the hippocampus and in clinical outcome after ECT.

Patient Characteristics Associated with Opioid Abstinence after Participation in a Trial of Buprenorphine versus Injectable Naltrexone

Background and Objectives: Better understanding of predictors of opioid abstinence among patients with opioid use disorder (OUD) may help to inform interventions and personalize treatment plans. This analysis examined patient characteristics associated with opioid abstinence in the X:BOT (Extended-Release Naltrexone versus Buprenorphine for Opioid Treatment) trial. Methods: This post-hoc analysis examined factors associated with past-month opioid abstinence at the 36-week follow-up visit among participants in the X:BOT study. 428 participants (75% of original sample) attended the visit at 36 weeks. Logistic regression models were used to estimate the probability of opioid abstinence across various baseline sociodemographics, clinical characteristics, and treatment variables. Results: Of the 428 participants, 143 (33%) reported abstinence from non-prescribed opioids at the 36-week follow-up. Participants were more likely to be opioid abstinent if randomized to XR-NTX (compared to BUP-NX), were on XR-NTX at week 36 (compared to those off OUD pharmacotherapy), successfully inducted onto either study medication, had longer time on study medication, reported a greater number of abstinent weeks, or had longer time to relapse during the 24-week treatment trial. Participants were less likely to be abstinent if Hispanic, had a severe baseline Hamilton Depression Rating (HAM-D) score, or had baseline sedative use. Conclusions: A substantial proportion of participants was available at follow-up (75%), was on OUD pharmacotherapy (53%), and reported past-month opioid abstinence (33%) at 36 weeks. A minority of patients off medication for OUD reported abstinence and additional research is needed exploring patient characteristics that may be associated with successful treatment outcomes.

Efficacy of escitalopram for poststroke depression: a systematic review and meta-analysis

Depression is very common after stroke, causing multiple sequelae. We aimed to explore the efficacy of escitalopram for poststroke depression (PSD). PubMed, Embase, Scopus, Cochrane Central Register of Controlled Trials, Clinical trials. gov, Wan fang Data (Chinese), VIP (Chinese) and CNKI (Chinese) were retrieved from inception to May 2021. We recruited Randomized Controlled Trials (RCTs) which met the inclusion criteria in our study. The depression rating scores, the incidence of PSD, adverse events as well as functional outcomes were analyzed. 11 studies and 1374 participants were recruited in our work. The results were depicted: the reduction of depression rating scores was significant in the escitalopram groups and the standard mean difference (SMD) was − 1.25 (P < 0.001), 95% confidence interval (95% CI), − 1.82 to − 0.68; the risk ratio (RR) of the incidence of PSD was 0.52 (95% CI, 0.29 to 0.91; P = 0.007 < 0.05), which was significantly lower in the escitalopram groups; Escitalopram is safe for stroke patients; there was improvement of the motor function. However, in sensitivity analyses, the conclusions of the motor function and the incidence of drowsiness were altered. The study suggests that escitalopram has a potentially effective role compared with control groups and demonstrates escitalopram is safe. However, the results of the motor function and the incidence of drowsiness should be considered carefully and remain to be discussed in the future.

Saffron as a Treatment for Mild to Moderate Depression: A Revision of Current Literature

Mild to moderate depression (MMD) is becoming a health burden due to its increasing prevalence. Current treatment options are not effective in all patients. Hence, researchers have studied herbal options. It has emerged in research that saffron can be used for the treatment of MMD due to its anti-depressant properties. This literature review focussed on the treatment of MMD by comparing saffron to placebo and current antidepressants. Overall, research has shown that saffron reduces depression rating scores, but little is known about its safety and toxicity. Thus, this literature review concluded that there is inconsistent evidence to recommend saffron for the treatment of MMD. Further research is of high clinical need to resolve the growing burden of MMD.

Large-scale structural network change correlates with clinical response to rTMS in depression.

Response to repetitive transcranial magnetic stimulation (rTMS) among individuals with major depressive disorder (MDD) varies widely. The neural mechanisms underlying rTMS are thought to involve changes in large-scale networks. Whether structural network integrity and plasticity are associated with response to rTMS therapy is unclear. Structural MRIs were acquired from a series of 70 adult healthy controls and 268 persons with MDD who participated in two arms of a large randomized, non-inferiority trial, THREE-D, comparing intermittent theta-burst stimulation to high-frequency rTMS of the left dorsolateral prefrontal cortex (DLPFC). Patients were grouped according to percentage improvement on the 17-item Hamilton Depression Rating Score at treatment completion. For the entire sample and then for each treatment arm, multivariate analyses were used to characterize structural covariance networks (SCN) from cortical gray matter thickness, volume, and surface area maps from T1-weighted MRI. The association between SCNs and clinical improvement was assessed. For both study arms, cortical thickness and volume SCNs distinguished healthy controls from MDD (p = 0.005); however, post-hoc analyses did not reveal a significant association between pre-treatment SCN expression and clinical improvement. We also isolated an anticorrelated SCN between the left DLPFC rTMS target site and the subgenual anterior cingulate cortex across cortical measures (p = 0.0004). Post-treatment change in cortical thickness SCN architecture was associated with clinical improvement in treatment responders (p = 0.001), but not in non-responders. Structural network changes may underpin clinical response to rTMS, and SCNs are useful for understanding the pathophysiology of depression and neural mechanisms of plasticity and response to circuit-based treatments.

Treating Insulin Resistance With Metformin as a Strategy to Improve Clinical Outcomes in Treatment-Resistant Bipolar Depression (the TRIO-BD Study): A Randomized, Quadruple-Masked, Placebo-Controlled Clinical Trial.

Objective: Therapeutic options are limited for treatment-resistant bipolar depression (TRBD). Insulin resistance (IR) confers increased risk for TRBD. We investigated metformin, an insulin sensitizer, to reverse IR and improve clinical outcomes in TRBD.Methods: Using a random-assignment (1:1), intent-to-treat, 2-site, quadruple-masked, parallel-group (metformin to 2,000 mg/d or placebo) clinical trial design, patients with DSM-5 bipolar disorder (BD) type I or II and IR received study medication for 26 weeks (February 2016 to October 2019). The primary outcome was the change in depression rating scores (Montgomery-Asberg Depression Rating Scale [MADRS]) at 14 weeks between those who no longer met IR criteria (converters) and those who still did (non-converters). Additional outcomes included scores on the Global Assessment of Functioning (GAF); the Clinical Global Impressions Scale, Bipolar Disorders version (CGI-BP); and the Hamilton Anxiety Rating Scale (HAM-A) and maintenance of improved outcomes up to 26 weeks.Results: Forty-five BD patients were randomized to metformin (n = 20) or placebo (n = 25), and at 14 weeks or later, 11 subjects no longer met IR criteria (n = 10 with metformin, n = 1 with placebo; P = .0009). These converters experienced significant improvements in MADRS (P values ranged from .031 to .008) and GAF (P values ranged from .045 to .008) scores compared to non-converters beginning at week 6, sustained to week 26. HAM-A (P = .022 at week 14 and .019 at week 26) and CGI-BP change scores (P = .046 at 26 weeks) significantly favored converters over non-converters. Effect sizes were large for the MADRS and GAF (Cohen d > 1 at 14 and 26 weeks) and large for the HAM-A and CGI-BP at 26 weeks. Transient gastrointestinal side effects occurred under both treatment conditions.Conclusions: Pending replication, this early study suggests that reversal of IR by metformin offers a path out of TRBD. Further characterization of metformin converters with TRBD will prove informative.Trial Registration: ClinicalTrials.gov identifier: NCT02519543.

Prevalence of Anxiety and Depression in Pregnant Women at Tertiary Care Hospital

Background: Pregnancy is a period of strength and optimism for a woman, even though it is a period of vulnerability. As many as one in ten new mothers have clinical depression or anxiety before or throughout the first year after the delivery of a baby, regardless of financial status. Objective: To evaluate prevalence of anxiety and depression in pregnant women at tertiary care hospital Methodology: This cross sectional study was carried out at the department of Obstetrics and Gynaecology, Women and Children Hospital, Charsadda for a period of six months from July 2021 to December 2021. A total of 250 pregnant women were included in our study based on WHO, sample size calculator. To assess Anxiety and depression, Hamilton anxiety rating scale and Hamilton depression rating scale were employed. IBM SPSS version 24 was used for all the data analysis. Results: Based on Hamilton depression rating score, amongst 250 participants, 47 (18.8%) participants were normal, 75 (30%) participants were observed with mild depression, moderate depression was observed in 70 (28%) participants, severe depression was observed in 33 (13.2%) participants and very severe depression was observed in 25 (10%) participants while Based on Hamilton anxiety rating score, the number of participants in normal, mild, moderate and severe anxiety range were 88 (35.2%), 45 (18%), 171 (31.2%) and 39 (15.2%) respectively. Conclusion: Our study concludes that depression and anxiety is highly prevalent in our population. Majority of the women from rural areas were uneducated. Keywords: Prevalence; Anxiety; Depression; Pregnancy

Electrophysiological correlates and predictors of the antidepressant response to repeated ketamine infusions in treatment-resistant depression

BackgroundSub-anesthetic ketamine doses rapidly reduce depressive symptoms, although additional investigations of the underlying neural mechanisms and the prediction of response outcomes are needed. Electroencephalographic (EEG)-derived measures have shown promise in predicting antidepressant response to a variety of treatments, and are sensitive to ketamine administration. This study examined their utility in characterizing changes in depressive symptoms following single and repeated ketamine infusions. MethodsRecordings were obtained from patients with treatment-resistant major depressive disorder (MDD) (N = 24) enrolled in a multi-phase clinical ketamine trial. During the randomized, double-blind, crossover phase (Phase 1), patients received intravenous ketamine (0.5 mg/kg) and midazolam (30 μg/kg), at least 1 week apart. For each medication, three resting, eyes-closed recordings were obtained per session (pre-infusion, immediately post-infusion, 2 h post-infusion), and changes in power (delta, theta1/2/total, alpha1/2/total, beta, gamma), alpha asymmetry, theta cordance, and theta source-localized anterior cingulate cortex activity were quantified. The relationships between ketamine-induced changes with early (Phase 1) and sustained (Phases 2,3: open-label repeated infusions) decreases in depressive symptoms (Montgomery-Åsberg Depression Rating Score, MADRS) and suicidal ideation (MADRS item 10) were examined. ResultsBoth medications decreased alpha and theta immediately post-infusion, however, only midazolam increased delta (post-infusion), and only ketamine increased gamma (immediately post- and 2 h post-infusion). Regional- and frequency-specific ketamine-induced EEG changes were related to and predictive of decreases in depressive symptoms (theta, gamma) and suicidal ideation (alpha). Early and sustained treatment responders differed at baseline in surface-level and source-localized theta. ConclusionsKetamine exerts frequency-specific changes on EEG-derived measures, which are related to depressive symptom decreases in treatment-resistant MDD and provide information regarding early and sustained individual response to ketamine.Clinical Trial Registration: ClinicalTrials.gov: Action of Ketamine in Treatment-Resistant Depression, NCT01945047

Omega-3 as an Adjunctive Therapy of Sertraline and Venlafaxine Substantially Improves Symptoms of Major Depressive Disorder: A Double-blind, Placebo-controlled Study

Background: Due to the possible effect of omega-3 fatty acids on reducing depressive symptoms, in this study, we investigated these effects in combination with other antidepressants. Methods: The study was a double-blind clinical trial on 100 patients with major depressive disorder who were divided into four groups of 25 each and treated with 50 mg daily sertraline plus placebo, 50 mg daily sertraline plus two grams Omega 3 daily, 75 mg daily venlafaxine plus placebo, and 75 mg daily venlafaxine plus 2 g Omega 3 daily for 6 weeks. Results: The mean Hamilton depression rating score of sertraline and venlafaxine plus omega-3 after treatment were 4.42 and 4.23 respectively versus sertraline and venlafaxine plus placebo 14.4 and 14.2 respectively (P value=0.0001). Conclusion: Omega-3 enhanced the clinical function of sertraline and venlafaxine to reduce the severity of depression. Adding omega-3 to either sertraline or venlafaxine does not have a comparative advantage over each other in terms of the improvement of severity of depressive symptoms.

Comparative efficacy of mitochondrial agents for bipolar disorder during depressive episodes: a network meta-analysis using frequentist and Bayesian approaches.

Mitochondrial dysfunctions have emerged as new biological hypothesis and therapeutic target for bipolar disorder. This network meta-analysis has been done to evaluate the comparative efficacy of mitochondrial agents in bipolar depression. After a comprehensive literature search on PubMed/MEDLINE, Cochrane databases, and International Trials Registry Platform, efficacy data were extracted from 15 randomized controlled trials. Random-effects meta-analysis was done following both frequentist and Bayesian approaches to pool the effects across the interventions. A network graph was built, relative effects of interventions in respect to one another and placebo were calculated, and treatments were ranked as per P- and SUCRA scores. Change in depression rating score was the primary outcome. Data was entered in contrast level and arm level for frequentist and Bayesian approaches, respectively. Amongst mitochondrial agents, N-acetylcysteine (NAC) was shown to have the highest probability of being the best treatment, followed by coenzyme Q10 and combination therapy of alpha-lipoic acid (ALA) and acetyl-L-carnitine (ALCAR) as depicted by P- and SUCRA scores. In the Bayesian approach, none of the treatments had better efficacy than placebo, but in the frequentist approach, NAC (effect estimate: - 1.18 (95% CI: - 2.05; - 0.31)) was significantly better than placebo. Methodically, there may be a difference of magnitude in frequentist and Bayesian approaches, but the direction of effect and ranking probabilities do not differ. We conclude that none of the existing mitochondrial agents showed better efficacy than placebo in bipolar depression regarding depression rating scores.

Assessment of Gender Differences in Depression- A Cross-Sectional study

Background and Aim: Major depression in both women and men is a debilitating disorder that disrupts relationship and daily lives and affects nearly 10% of general populations. The aims and objectives of this study were to determine the gender differences in major depression with respect to following: Demographic characteristics, Clinical manifestations, Stressful life events, Risk factors.&#x0D; Materials and Methods: Total of 100 patients was included in the study. All the included patients meet the criteria for DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) diagnosis of major depression. The included patients were interviewed at the department of Psychiatry, B. J. Medical College &amp; civil hospital Ahmedabad. Based on the Life Events Scale by Holmes and Rahe (1967), its Indian adaptation PSLE (Presumptive stressful life events scale) was done by Gurmeet Singh (1983). The statistical analysis was done by using SPSS IX version.&#x0D; Results: Their ages range from 18 to 70 years. Most of the patients were married, were from urban background, and nuclear family. On Hamilton Depression rating scale when the statistical analysis was done, there was no significant difference between males and females. Men had higher mean life events score than women but this was not statistically significant. In female, there was significant positive correlation between number of life events in one year and severity of depression as well as impact score during one year prior to onset of depression and Hamilton rating scores.&#x0D; Conclusion: Male and female major depression patients did not differ as regards demographic characteristics, except that most women were homemakers and men were employed. Number of stressful life events experienced during 1 year prior to onset of MDD was similar. Early insomnia, middle insomnia and somatic symptoms general were more severely present in female patients.

Ketamine for Bipolar Depression: A Systematic Review.

BackgroundKetamine appears to have a therapeutic role in certain mental disorders, most notably unipolar major depressive disorder. However, its efficacy in bipolar depression is less clear. This study aimed to assess the efficacy and tolerability of ketamine for bipolar depression.MethodsWe conducted a systematic review of experimental studies using ketamine for the treatment of bipolar depression. We searched PubMed, MEDLINE, Embase, PsycINFO, and the Cochrane Central Register for relevant studies published since each database’s inception. We synthesized evidence regarding efficacy (improvement in depression rating scores) and tolerability (adverse events, dissociation, dropouts) across studies.ResultsWe identified 6 studies, with 135 participants (53% female; 44.7 years; standard deviation, 11.7 years). All studies used 0.5 mg/kg of add-on intravenous racemic ketamine, with the number of doses ranging from 1 to 6; all participants continued a mood-stabilizing agent. The overall proportion achieving a response (defined as those having a reduction in their baseline depression severity of at least 50%) was 61% for those receiving ketamine and 5% for those receiving a placebo. The overall response rates varied from 52% to 80% across studies. Ketamine was reasonably well tolerated; however, 2 participants (1 receiving ketamine and 1 receiving placebo) developed manic symptoms. Some participants developed significant dissociative symptoms at the 40-minute mark following ketamine infusion in 2 trials.ConclusionsThere is some preliminary evidence supporting use of intravenous racemic ketamine to treat adults with bipolar depression. There is a need for additional studies exploring longer-term outcomes and alterative formulations of ketamine.

A Prospective Observational Study on the Effects of Antidepressant Treatment on Hypothalamic-Pituitary-Adrenal Axis Regulation in Treatment-Resistant Depression

Introduction: Dysregulation of Hypothalamic-Pituitary-Adrenal (HPA) axis can reduce the effects of antidepressants. Salivary cortisol level and Hamilton Depression Rating (HAM-D) score can be used to assess the level of improvement in the HPA axis and depressive disorders. Aim: To evaluate the changes in salivary cortisol level and HAM-D score in patients of Treatment Resistant Depression (TRD) and to investigate the association between them. Materials and Methods: The present prospective cohort study was conducted in the Department of Pharmacology and Psychiatry at Pt. JNM Medical College and Dr. BRAM Hospital Raipur (CG) over a period of one year, from June 2014 to June 2015. The participants were 52 diagnosed cases of TRD according to Diagnostic and Statistical Manual of Mental Disorders (DSM IV) criteria, who were taking antidepressant medications for at least four weeks. The salivary cortisol values and HAM-D scoring were done at baseline and follow-up at 8 weeks and 16 weeks and compared by student’s t-test and one-way ANOVA. Results: A significant difference (p&lt;0.001) was noted in the mean salivary cortisol levels (1.15±0.31 and 0.72±0.24) mean HAM-D (29.67±1.43 and 16.26±7.08) scores at baseline and subsequent follow-up respectively. Conclusion: The therapeutic benefit of antidepressants could be due to alteration of HPA axis functioning.

Comparison of clinical efficacy of oxcarbazepine and lamotrigine combined with escitalopram, and impact on prognostic quality of life in treating patients with epilepsy and depressive disorder.

This study aimed to investigate the clinical efficacy of oxcarbazepine and lamotrigine combined with escitalopram in treating patients with epilepsy and depressive disorder, and their influence on the prognostic quality of life. A total of 108 patients with epilepsy and depression were selected as research participants. Among them, 53 patients were treated by oxcarbazepine combined with escitalopram (group A) and 55 patients were treated by lamotrigine combined with escitalopram (group B). Following six-month treatment, efficacy, epilepsy frequency and duration, Hamilton Depression Rating (HAMD) and Montgomery-Asberg Depression Rating (MADRS) scores, adverse reactions, improvement of electroencephalogram (EEG) epileptic discharge, quality of life, 1-year drug retention rate and withdrawal reasons of the two groups were compared. There was no remarkable difference in the total efficacy rate between both groups. The number and duration of epileptic seizures, improvement of EEG epileptic discharge and quality of life in the two groups significantly improved after treatment, with no marked difference. HAMD and MADRS scores of patients from group B were significantly lower after treatment compared with those of patients from group A. The incidence rate of adverse reactions in group B was dramatically lower compared with group A, and the 1-year drug retention rate of group B was dramatically higher compared with that in group A. Both oxcarbazepine and lamotrigine combined with escitalopram exhibited good efficacy in patients with epilepsy and depressive disorder, and they may effectively improve the prognostic quality of life of patients. Lamotrigine combined with escitalopram presented with a better antidepressant effect and safety, with higher patient tolerance.